This study aimed to develop an explainable early diagnostic model for Mycoplasma pneumoniae (MP) infection in children and assess clinicians' perceptions before and after its deployment. Data were collected from children with acute fever or cough at Linyi Maternal and Child Healthcare Hospital and Shanghai Children's Medical Center in 2023. Serology-defined MP infection was determined based on a fourfold or greater change in MP-IgM or MP-IgG titers between the acute and convalescent phases. Patients were split into training and test sets at a 7:3 ratio, and temporal validation was performed using data collected in 2024. PCR testing was not systematically available in this cohort and was therefore not used as a comparator or reference standard. Recursive Feature Elimination (RFE) optimized feature selection. Seven models were developed; the best was chosen based on AUC value and interpreted using SHAP. Models were deployed via Streamlit, and clinician feedback was surveyed before and after three months of use. The optimal model, using 11 features, achieved AUCs of 0.89 in the internal test set and 0.84 in the temporal validation cohort for identifying serology-defined MP infection, with TNFβ and IL-2 emerging as high-impact features. Separate models for under and over 60-month-old children also performed well. Clinicians' trust in the model significantly increased after three months (P < 0.001) and was correlated with usage frequency (P < 0.01). We developed explainable models to support the early identification of serology-defined MP infection in children. TNFβ and IL-2 may represent informative immune-related features, although further PCR-based validation and mechanistic studies are needed. Clinician trust and usage increased after model deployment.

Stelleropsis tianschanica Pobed. is a perennial herb belonging to the genus Stelleropsis in the family Thymelaeaceae of the order Myrtales, and possesses certain toxicity. In the Zhaosu region of Xinjiang, it is used medicinally as an expectorant and analgesic, and for the treatment of chronic bronchitis, cough, asthma, and skin diseases. However, beyond its therapeutic efficacy, the potential hepatotoxicity of Stelleropsis tianschanica Pobed. poses a threat to human health. Currently, research regarding its hepatotoxicity remains limited.

Respiratory infectious diseases remain a major global public health challenge. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Influenza A Virus (IAV), and Mycoplasma pneumoniae (MP), as three representative respiratory pathogens, all clinically cause airway epithelial shedding, ciliary dysfunction, and Acute Respiratory Distress Syndrome (ARDS). Notably, they are the common triggers of acute respiratory infections characterized by persistent and severe cough, a clinical hallmark rooted in the structural disintegration of the airway mucosal barrier. However, the molecular mechanisms by which they compromise the airway mucosal barrier exhibit significant heterogeneity. Currently, there is a paucity of systematic reviews offering a comparative analysis between these viral and atypical bacterial pathogens. This review comprehensively examines the pathogenic mechanisms of these three agents across four dimensions: receptor recognition, direct cytotoxicity, immunopathology, and abnormal tissue repair. Studies indicate that during the invasion phase, SARS-CoV-2 relies on the Angiotensin-converting enzyme 2 (ACE2) receptor and Transmembrane protease, serine 2 (TMPRSS2) -mediated membrane fusion; IAV identifies sialic acid receptors via hemagglutinin, whereas MP utilizes specialized attachment organelles for "gliding" colonization. Regarding cellular injury mechanisms, SARS-CoV-2 primarily hijacks the endoplasmic reticulum (ER) to induce stress responses and promote syncytium formation; IAV predominantly targets mitochondria to trigger apoptosis and cellular necrosis; while MP utilizes hydrogen peroxide and Community-Acquired Respiratory Distress Syndrome (CARDS) toxin to implement oxidative damage and vacuolating toxicity. At the immunopathological level, SARS-CoV-2-induced delayed interferon response and cytokine storm, IAV-triggered excessive formation of neutrophil extracellular traps (NETs), and MP-mediated activation of the NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome are key drivers exacerbating airway injury. Furthermore, distinct acute injury mechanisms determine differentiated long-term prognoses, such as pulmonary fibrosis, airway hyperresponsiveness, and airway remodeling. In summary, elucidating the commonalities and specificities of these mechanisms has significant clinical guidance value for precisely distinguishing clinical phenotypes, predicting disease progression, and developing host-directed therapies targeting specific injury pathways.

E-cigarette or vaping-associated lung injury (EVALI) remains an important but often overlooked cause of acute respiratory failure, particularly in the years following the COVID-19 pandemic. We describe a middle-aged woman with a recent history of nicotine-only vaping who presented with worsening cough, dyspnoea on exertion and progressive hypoxia. Imaging initially suggested multifocal pneumonia, and she was started on broad-spectrum antibiotics and bronchodilator therapy. Despite this, she continued to deteriorate, prompting intensive care unit transfer and initiation of high-dose corticosteroids. Extensive workup including infectious, autoimmune and vasculitis panels was negative. Given her history of recent vaping, EVALI was considered the most likely aetiology. Her clinical course improved significantly after corticosteroid therapy, and she was discharged on a steroid taper. This case highlights the diagnostic challenges posed by EVALI and the ongoing risk associated with vaping, including those containing only nicotine. This case report aims to contribute to the ongoing clinical awareness of EVALI.

SummaryWe present a case of allergic bronchopulmonary mycosis due to Saccharomyces cerevisiae mimicking lung cancer in an immunocompetent woman in her early 70s. She had a 6-week history of dry cough and chest X-ray changes concerning for malignancy. CT initially suggested primary lung cancer. Blood tests showed eosinophilia (4.2×10[9]/L) and moderately elevated total IgE (296 IU/mL). Aspergillus precipitins were mildly raised (140 mgA/L), but no Aspergillus-specific growth or serological sensitisation was found. She developed acute respiratory distress requiring emergency cardiothoracic intervention for near-total collapse of the left lung caused by occlusion of the left main bronchus, initially presumed malignant. Bronchoscopy revealed a large mucus plug obstructing the bronchus, which was removed, with no visual tumour. Bronchial washings showed reactive bronchial epithelium without malignancy, and sputum cultures taken during bronchoscopy identified Saccharomyces cerevisiae.

Since emerging in December 2019, SARS-CoV-2 has led to significant morbidity and mortality globally. While much is known about SARS-CoV-2 infection and sequelae, fewer studies have been conducted in sub-Saharan Africa. This study was conducted to characterize acute and persistent symptoms of COVID-19 among adults and children in rural Zambia. From December 2020 to March 2022, individuals of all ages with acute SARS-CoV-2 infection (n = 132) were recruited into a cohort study. For comparison, individuals with acute influenza infection (n = 56) were also recruited. Participants were followed at 30, 90, 180, and 365 days. Most adult COVID-19 participants (median age: 36 years; 54% male; 11% had received the COVID-19 vaccine) were symptomatic at enrollment (92%), but few were hospitalized (9%). The most common symptoms were cough, headache, fever, and body aches. Most symptoms resolved by 30 days; the proportion reporting symptoms at follow-up visits ranged from 11% to 19%. Common symptoms at follow-up visits included cough, runny nose, headache, body aches, and fatigue. Similarly, most child COVID-19 participants (86%) were symptomatic at enrollment (median age: 13 years; 57% male; none had received the COVID-19 vaccine) and none were hospitalized. The most common symptoms were cough, fever, headache, and runny nose with most symptoms resolving by 30 days. The proportion reporting symptoms at follow-up visits ranged from 13% to 20%. Common symptoms included cough, fever, headache and runny nose. For comparison, adult and child participants with influenza virus infection were evaluated. The proportion reporting symptoms at follow-up visits ranged from 16% to 32%. This study adds to the literature on the clinical characteristics of acute SARS-CoV-2 infection and persistent symptoms in the first two years of the pandemic in an underrepresented region.

Cough is one of the most common reasons for health care visits. This article seeks to illustrate the classification, appropriate workup, and management of acute and subacute cough. It highlights etiologies such as bronchitis, pneumonia, and exacerbation of heart failure and asthma. There is an emphasis placed on potentially life-threatening pathologies associated with cough and how to appropriate triage cough severity in an emergency setting. The pathophysiology of cough and how it may lead to severe barotraumatic complications such as pneumothorax and Mallory Weiss tears is discussed.